TREATMENT OF NONUNION OF LATERAL HUMERAL CONDYLE FRACTURE COMBINED WITH CUBITUS VALGUS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUQi , CHENMang ,  ZHOUMin , LIAOChunlai , CAIJundong

1. Department of Trauma Orthopedics, the 188th Hospital of Chinese PLA, Chaozhou Guangdong, 521000, P. R. China;
2. Department of Bone and Joint Surgery, the 188th Hospital of Chinese PLA, Chaozhou Guangdong, 521000, P. R. China;

Corresponding?author：

ZHOUMin, Email: 1192396762@qq.com

Keywords：

Lateral humeral condyle fracture; Bone nonunion; Cubitus valgus deformity

DOI：

10.7507/1002-1892.20140092

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Objective To investigate the surgical procedures and results of nonunion of lateral humeral condyle fracture combined with cubitus valgus. Methods Between January 2006 and September 2011, 19 cases of nonunion of lateral humeral condyle fracture combined with cubitus valgus were treated with supracondylar closing wedge osteotomy, open reduction, autogenous bone grafting, and internal fixation. There were 11 males and 8 females, aged 14-28 years (mean, 21.6 years). The left side was involved in 7 cases, and the right side in 12 cases. The disease duration was 3-22 years (mean, 9 years). The osseous protuberance and enlargement were seen in the lateral condyle of all the cases, with cubitus valgus. Compared with the contralateral side, the angle of cubitus valgus deformity increased (34.00±7.68)° at the affected side. The elbow range of motion of flexion and extension was (117.35±19.77)° in the other 17 patients except 2 patients with joint stiff. Among them, 10 patients had limited mobility. Three patients had ulnar neuritis. Results All the patients obtained primary healing of incision, and no surgery-related complication occurred. Nineteen patients were followed up 2-6 years (mean, 3.2 years). Bony union at lateral condylar fracture site and the supracondylar osteotomy site was achieved in all cases within 6 months postoperatively. In 3 patients with ulnar neuritis, the symptoms of nerve injury disappeared within 6 months. At last follow-up, the angle of cubitus valgus deformity increased (3.21±4.09)° at the affected side when compared with the contralateral side, showing significant difference when compared with preoperative angle (t=30.472, P=0.000). The range of motion of the elbow was 20° and 30° in 2 patients with joint stiff before operation; the elbow range of motion of flexion and extension was (117.64±15.72)° in the other 17 patients, showing no significant difference when compared with preoperative value (t=-0.180, P=0.859). According to the appearance of the elbow, range of motion, and complications, the overall results were classified as excellent in 9 patients, good in 8 patients, and poor in 2 patients; the excellent and good rate was 89.5%. Conclusion Supracondylar closing wedge osteotomy can correct the cubitus valgus deformity and improve the symptoms of ulnar neuritis. Open reduction, autogenous bone grafting, and internal fixation for nonunion of the lateral condyle can effectively stabilize the lateral condylar fracture and promote fracture healing.

Citation： SUQi, CHENMang, ZHOUMin, LIAOChunlai, CAIJundong. TREATMENT OF NONUNION OF LATERAL HUMERAL CONDYLE FRACTURE COMBINED WITH CUBITUS VALGUS. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(4): 406-409. doi: 10.7507/1002-1892.20140092 Copy

1.	Tejwani N, Phillips D, Goldstein RY. Management of lateral humeral condylar fracture in children. J Am Acad Orthop Surg, 2011, 19(6):350-358.
2.	袁華軍, 梁善榮. 兒童肱骨外髁骨折不愈合并肘外翻的手術治療. 中華小兒外科雜志, 2000, 21(6):374.
3.	羅漢文, 陳志維, 熊昌盛, 等. 肱骨外髁重建術治療肱骨外髁骨折骨不連并肘外翻畸形的遠期隨訪. 中國骨傷, 2006, 19(5):302.
4.	Meyer NJ, Lyon RM. Lateral elbow ecchymosis as a clinical sign of lateral humeral condylar fractures. Am J Orthop (Belle Mead NJ), 2003, 32(5):260-261.
5.	Song KS, Kang CH, Min BW, et al. Internal oblique radiographs for diagnosis of nondisplaced or minimally displaced lateral condylar fractures of the humerus in children. J Bone Joint Surg (Am), 2007, 89(1):58-63.
6.	覃佳強, 封林, 李明, 等. 兒童肱骨外髁骨折后遺畸形的手術及康復治療. 中國矯形外科雜志, 2007, 15(18):1379-1381, 1399.
7.	Marcheix PS, Vacquerie V, Longis B, et al. Distal humerus lateral condyle fracture in children:when is the conservative treatment a valid option? Orthop Traumatol Surg Res, 2011, 97(3):304-307.
8.	Jenyo M, Mirdad T. Fracture of the lateral condyle ofthe humeras in children. East Afr Med J, 2001, 78(8):424-429.
9.	Agarwal A, Qureshi NA, Gupta N, et al. Management of neglected lateral condyle fractures of humerus in children:A retrospective study. Indian J Orthop, 2012, 46(6):698-704.
10.	張立軍, 吉士俊. 重視肱骨外髁骨折的規范化治療. 中國矯形外科雜志, 2012, 20(18):1633-1637.
11.	阿斯哈爾江·買買提依明, 阿德力·阿布都熱西提, 艾克拜爾·尤努斯. 髁上截骨和外側柱重建術治療肱骨外髁骨折不連伴肘外翻畸形. 中國修復重建外科雜志, 2009, 23(4):423-425.
12.	熊昌盛, 陳志維, 李逸群, 等. 肱骨遠端外柱重建治療的手術療效觀察. 中國矯形外科雜志, 2010, 18(10):859-861.
13.	封林, 覃佳強, 張德文, 等. 兒童肱骨外髁骨折后骨不連的治療. 中華創傷雜志, 2006, 22(11):869-870.
14.	楊源中, 謝強, 劉藝祥, 等. 肘外翻畸形的手術治療(附12例報告). 中國骨與關節損傷雜志, 2005, 20(4):263-264.
15.	劉剛, 鐘剛, 易敏, 等. 肘外翻畸形導致肘管綜合征的相關因素分析. 中國修復重建外科雜志, 2010, 24(8):967-971.
16.	沈品泉, 張菁, 陳珽. 兒童陳舊性肱骨外髁骨折的治療. 中國修復重建外科雜志, 2007, 21(3):266-268.
17.	張作君, 牛素玲, 朱文瀟. 肱骨外髁骨折不愈合伴發育不全的手術治療. 中國骨與關節損傷雜志, 2009, 24(1):47-49.
18.	牛云飛, 張春才, 禹寶慶, 等. 重建髁部治療肱骨髁上髁間嚴重骨缺損性骨不連. 中國修復重建外科雜志, 2008, 22(1):36-39.

1. Tejwani N, Phillips D, Goldstein RY. Management of lateral humeral condylar fracture in children. J Am Acad Orthop Surg, 2011, 19(6):350-358.
2. 袁華軍, 梁善榮. 兒童肱骨外髁骨折不愈合并肘外翻的手術治療. 中華小兒外科雜志, 2000, 21(6):374.
3. 羅漢文, 陳志維, 熊昌盛, 等. 肱骨外髁重建術治療肱骨外髁骨折骨不連并肘外翻畸形的遠期隨訪. 中國骨傷, 2006, 19(5):302.
4. Meyer NJ, Lyon RM. Lateral elbow ecchymosis as a clinical sign of lateral humeral condylar fractures. Am J Orthop (Belle Mead NJ), 2003, 32(5):260-261.
5. Song KS, Kang CH, Min BW, et al. Internal oblique radiographs for diagnosis of nondisplaced or minimally displaced lateral condylar fractures of the humerus in children. J Bone Joint Surg (Am), 2007, 89(1):58-63.
6. 覃佳強, 封林, 李明, 等. 兒童肱骨外髁骨折后遺畸形的手術及康復治療. 中國矯形外科雜志, 2007, 15(18):1379-1381, 1399.
7. Marcheix PS, Vacquerie V, Longis B, et al. Distal humerus lateral condyle fracture in children:when is the conservative treatment a valid option? Orthop Traumatol Surg Res, 2011, 97(3):304-307.
8. Jenyo M, Mirdad T. Fracture of the lateral condyle ofthe humeras in children. East Afr Med J, 2001, 78(8):424-429.
9. Agarwal A, Qureshi NA, Gupta N, et al. Management of neglected lateral condyle fractures of humerus in children:A retrospective study. Indian J Orthop, 2012, 46(6):698-704.
10. 張立軍, 吉士俊. 重視肱骨外髁骨折的規范化治療. 中國矯形外科雜志, 2012, 20(18):1633-1637.
11. 阿斯哈爾江·買買提依明, 阿德力·阿布都熱西提, 艾克拜爾·尤努斯. 髁上截骨和外側柱重建術治療肱骨外髁骨折不連伴肘外翻畸形. 中國修復重建外科雜志, 2009, 23(4):423-425.
12. 熊昌盛, 陳志維, 李逸群, 等. 肱骨遠端外柱重建治療的手術療效觀察. 中國矯形外科雜志, 2010, 18(10):859-861.
13. 封林, 覃佳強, 張德文, 等. 兒童肱骨外髁骨折后骨不連的治療. 中華創傷雜志, 2006, 22(11):869-870.
14. 楊源中, 謝強, 劉藝祥, 等. 肘外翻畸形的手術治療(附12例報告). 中國骨與關節損傷雜志, 2005, 20(4):263-264.
15. 劉剛, 鐘剛, 易敏, 等. 肘外翻畸形導致肘管綜合征的相關因素分析. 中國修復重建外科雜志, 2010, 24(8):967-971.
16. 沈品泉, 張菁, 陳珽. 兒童陳舊性肱骨外髁骨折的治療. 中國修復重建外科雜志, 2007, 21(3):266-268.
17. 張作君, 牛素玲, 朱文瀟. 肱骨外髁骨折不愈合伴發育不全的手術治療. 中國骨與關節損傷雜志, 2009, 24(1):47-49.
18. 牛云飛, 張春才, 禹寶慶, 等. 重建髁部治療肱骨髁上髁間嚴重骨缺損性骨不連. 中國修復重建外科雜志, 2008, 22(1):36-39.

Chinese Journal of Reparative and Reconstructive Surgery

TREATMENT OF NONUNION OF LATERAL HUMERAL CONDYLE FRACTURE COMBINED WITH CUBITUS VALGUS

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